Tuesday, December 01, 2009

How can you really ever know?

A few weeks ago Micah had a swallow study. I was assured that the cost of this was covered by insurance. And we met our deductible a LONG time ago. So am I surprised that I just got a bill for almost $300? Not really. How can you ever really know how they're going to bill something??

We're well aware that we have no more Speech therapy benefits this year. Micah used them up with the early intervention and cannot have any more private sessions until January. We looked into it because of his feeding issues. So, if I had been told in advance that there would be a charge in the swallow study charges including speech therapy, I would have had to wait until January to have it done. But I wasn't. Hence the bill.

Is there really any way to know that everything will be covered before having a procedure done?? I want to see the itemized bill in advance. Wouldn't that be something?

I also have a lovely bill for over $4k sitting here. The company that is covering Emma's therapy has refused to pay. Seriously. Four times, so the bill was sent to me. After I was so excited that she could have the therapy and got approval, and the therapy company got approval... and now... the bill. We'll be working on that one for sure. But in the mean time these things just stress me out. Who has time to mess with people that don't cover what they should cover? And who has the $$ not to?


  1. You have my sympathy. I have no idea what my policy covers how anymore after a law changed in this state a couple months ago that drastically improved my coverage. (Mental health is covered like any other illness. With a recent psych hospitalization and lots of psych visits of various flavors this is a big deal.) I'm very happy, of course, but also have no idea now what anything will cost or how it will be covered. I was in the ER this weekend and I have no idea if everything will be covered under my met deductible or not, although I think it is. But my only way to know is to wait for those bills to show up. And then I will remember to request a new policy.......

  2. I am right with you. It drives me nuts to have a procedure done, then get a bill...then a few months later a bill for some other part of the procedure, then a few months later another bill...all for different things relating to the same procedure! Just when I think I've got everything paid up another one shows up!

  3. Each procedure, dr visit, shot, therapy, etc. has CPT codes, or the codes that tell the insurance precisely what was done. Charges are assigned to these codes and insurances approve or deny based on these codes. There is NO way to be 100% sure what is covered since every insurance company will refuse to "guarantee benefits" until they get the bill. BUT you can call the insurance company with the CPT codes prior to the procedure or visit and they should be able to tell you how that code falls in their benefit model for your policy.

    Of course, once they have given the green light for a CPT code, it can still be denied due to a ICD code (diagnosis) that is not covered as well. It's a constant battle... if I hadn't worked in it for years, I'd be certifiable by now--mentally, that is. :o)